Have jittery feeling in throat. Have seen 3 clinicians, now what?
February 1, 2013 9:30 AM   Subscribe

Medical Issue: I have a subtle jittery/ticking sensation in my throat and I've seen a doctor and 2 PAs and no one seems to know what is going on. What should be my next steps? Important details inside.

About a month ago I started getting what I can best describe as an internal jitter/ticking/twitching sensation in my throat/neck area. This sensation is all the time, relatively subtle, and generally doesn't bother me. However does increase in intensity at times, especially the morning when I am just waking and while it is never painful it bothers me greatly.

I went to the doctor, they gave me an EKG (normal) and sent me home with a 24 hour heart monitor (ECG?) which showed I have bradycardia (slow heart rate). Bradycardia might make sense for me. I am 33 year old maile and a fairly avid cycler in the summer months and my resting heart rate is routinely 50-60 beats per min. Although, it is now the winter and I live in a cold climate, so my cycling has been almost non existent and I don't get much exercise (other than walking the dog) otherwise. I have an appointment with a primary care PA to further review my results next week.

I've also been told to take omeprazole (Prilosec) and have been taking 20-40mg for the past 3 weeks. This hasn't seemed to help the sensation in my throat. They tested by blood for thyroid, lipids, psa, the usual work up. That came back that I had elevated LDL (133), but everything else was normal. My father did have a CABG (bypass) and has heart disease so this is a constant worry for me.

Throughout the day I have periods (maybe once per day while awake) where this feeling intensifies and it seems to start impacting the rest of my body. My hands start jittering and I feel like I have had 10 cups of coffee. This is similar to how I feel in the morning as well. So, the doc thought it might be stress and anxiety related (and all my google searching seems to indicate this) so they put me on 20mg of Celexa and Xanax. I have to admit the Xanax makes me feel normal. The feeling in my body goes away as soon as the Xanax kicks in and the jitter in my throat is reduced to hardly noticeable or even sometimes non-existent. I will also mention that the Celexa seems to have heighten my anxiety around this whole situation and has made the more intense daily occurrences worse and more frequent. But this could be a nature progression of whatever the underlying issue is, too.

I have had history of periods of moderate depression and anxiety in the past. But my worry is that there is some underlying issue (with my brain, CNS, heart, etc) that is causing this sensation and anxiety. Life has been pretty great otherwise, so I can't think of why I'd be stressed/depressed/anxious. Another odd thing is that when I am having these more intense periods in the morning, I can usually make it go away just by thinking about it and visualizing the sensation stoping (I know this sounds crazy, but it works).

Has anyone experienced anything like this before? Or, if there is a doc in the house what could this be? So, what are my next steps? I am worried that there might be something more serious going on (MS, parkinsons, ALS, heart failure, etc. )
posted by anonymous to Health & Fitness (11 answers total)
I cannot guarantee that it is anxiety, but I will say that as someone who has had periods of intense anxiety, I have caused myself symptoms like this. I have had all kinds of lumps in my throat and difficulty swallowing, for example, plus pain with swallowing...followed by a perfectly normal endoscopy and the abatement of the symptom, which had been caused by my anxiety all along. I also had about a year of crazy twitching all over my body - I had some inside-mouth twitches but no throat ones - that was kicked off by some perfectly normal muscle-twitching after unusual exercise followed by becoming half-convinced that I had ALS, reading the internet about it all the time, etc. The twitches were persistent and visible to the naked eye as well as being felt by me.

When I've had physical anxiety symptoms, sometimes it's been when I am under stress that I identify as stress and sometimes it's been when my unconscious has been all "everything is going so well, I don't know how to handle this, it must mean that the universe is preparing to smite me like with a terrible disease or something".

You may not be able to internalize this, but it is extremely unlikely that you have anything gravely wrong with you.

I can actually - although IANAD - say that it is ridiculously unlikely that you have ALS or Parkinson's based on this symptom. (Based on a whole year of reading everything on the web that I could find via PubMed, Cleveland Clinic, etc.) Mouth and throat twitching feelings in those conditions (especially ALS) are virtually always late stage symptoms that follow on others that are much more obvious.

Another odd thing is that when I am having these more intense periods in the morning, I can usually make it go away just by thinking about it and visualizing the sensation stoping (I know this sounds crazy, but it works).

This sounds like an anxiety issue to me.

One thing that has helped me in my perpetual fears that I am showing the first, tiniest signs of a terrible and usually incurable illness: I think to myself, "if this really is [Terrible Illness] I will eventually have worse and more definitive symptoms; there is almost nothing I can do about it anyway if it is [Terrible Illness] so I might as well focus on living for today; and until I have more obvious symptoms anyway the doctors won't be able to find anything." With enough practice, I have become able to acknowledge the worry and move on.

Also, I'm sure you know this but: if you are googling your symptoms, you must stop. Obsessive googling and reading really tipped me over from "I am undergoing some stress in my life and have some worries about these crazy twitches" to "I am convinced I am going to die in the next few years and am seriously starting to make plans for how I will get my loved ones through it while receiving the care I will need". Tell yourself that you will go to the doctor if it gets worse but until then you aren't going to think about it.
posted by Frowner at 9:44 AM on February 1, 2013 [3 favorites]

Hello, I am a doctor but not your doctor and I specialize in emergency medicine (which is not the type of problem this is, limiting the usefulness of my opinion).

I can only give you a very limited read on what you have said here, it would be irresponsible to pretend that I could suggest what this might be based on reading a few paragraphs on the internet, this is not a straightforward story enough that I could offer suggestions.

However, I can tell you that it's extremely unlikely to be any of the things you've suggested at the end of your post (MS, Parkinson's, heart failure, ALS), and the fact that you're even connecting these symptoms with those illnesses, most of which do not primarily manifest with the symptoms you're having, makes me a bit inclined to agree that it may be anxiety (yes, Parkinson's manifests with a tremor, but it's also extremely rare in people under 40 years of age!).

The bottom line is that you're perfectly within your rights to get this looked into further. There are other possible diagnoses here. Yes, it could be anxiety, but also anxiety or depression can be things that are misdiagnosed in people with other medical issues. I think it would be reasonable to get a second opinion.

I do not think you should count yourself as having "seen 3 clinicians". Nothing against PAs, but they are not physicians. They are great to deal with regular everyday medical issues, but when you're talking about something that's outside the norm or might not be what it seems, it doesn't matter how many PAs you've seen, they're not likely to get the diagnosis. The next step after an MD should be either another primary/internal medicine MD for a second opinion or a specialist MD.
posted by treehorn+bunny at 9:57 AM on February 1, 2013 [4 favorites]

Oh, I wanted to say two more things:

1. The bout of twitching that I referenced earlier took a while to die away, even after I had become convinced that it was benign and taken steps to address my anxiety. Even now, I occasionally get bouts of weird twitching (stomach muscles!) that I never used to have. I am convinced that my body in some way "learned how to" twitch more during the time I spent obsessed by twitching and is more primed to twitch (whether via a purely physical process or a mental-physical one) than it was before. So my point is that even when you get a diagnosis and become confident in it, it may take a while for your body to unlearn the twitching, and this doesn't necessarily mean Terrible Things.

2. Another useful mental habit I've found: when I have a symptom, I remind myself of all the many, many innocuous/curable/treatable things it can be besides Terrible Illness. IIRC, a turning point in my ALS-fears was stumbling across a really good article that talked about all the many things that could cause ALS-like symptoms. Prior to that I'd been googling things like "ALS and twitching" so naturally I got the impression that there were no minor causes of twitching. After doing this for a while, I now have a minor symptom and my first thought is "it is probably [most common thing]!" instead of looking for the terrible illness diagnosis.

(Also, does your depression/anxiety manifest itself in guilt and shame? Do you ever feel like "the universe will punish me if I am too happy, because I am a Bad Person and do not deserve it"? I feel like some of my episodes of anxiety have been produced because being happy itself makes me a bit anxious.)
posted by Frowner at 10:15 AM on February 1, 2013 [1 favorite]

Not ALS. Not. Random jittering/twitches at various points on the body sounds a lot more like BFS (Benign Fasiculation Syndrome).

There's a fair bit of info on BFS out there, some couched in medicalese, some in natural language. It may have its origins in anxiety, as Frowner describes above, although some people think that it may be correlated with B12 deficiency or a recent bout of flu that could have knocked things off kilter. Developing BFS does NOT put you at any higher risk for developing ALS, MS or any other neurological disorder in the future, and it doesn't mean there's some underlying terrible thing wrong with you.

I developed BFS at a time in my life when I was pretty active, not under any unusual stress, and eating well. It showed up, hung around, and freaked me out for a while. I finally figured out what it was, watched it with some amusement for a while, then it went away. In my experience, the symptoms were suggestible. I didn't try to turn them off, but I found that I could turn on a new symptom as soon as I learned about it. For example, after my doctor told me about his bout of BFS in medical school, which included some thumb twitching, I went home and after an hour or so, I developed a strong, visible twitch in my thumb. I was actually fascinated and delighted by that point because passing the exam and talking with the doctor had been so reassuring. (To clarify: I didn't TRY to turn on a thumb twitch: it just showed up.)

If you are really, really worried and nothing else helps, see a neurologist and have a proper workup. Get an EMG if you're still not reassured by the results of the workup. Then be prepared for this to fade away with time. If you can, come back here some time and help talk down some other poor soul who thinks these jitters are something dire.
posted by maudlin at 10:17 AM on February 1, 2013 [1 favorite]

I had a similar sensation happening toward the end of last year. I was under an incredible amount of stress, and described it as "like a fluttering bird was trying to escape from the base of my throat."

I had an EKG, then my doc did a 30 day (holter) heart monitor. Turns out I have Premature Ventricular Contractions. Mine happen sometimes, but not all the time, so a 24 hour monitor may not have picked them up, where the 30 day one did. It's apparently quite common, and usually benign.

Go figure, now that my stress has lessened, and I know what they are, I'm barely noticing them, where before I had this crazy idea I was gonna drop dead at any second.

I bring this up, just because the base of the throat thing seemed obviously similar, so perhaps it's worth bringing up to your doc.
posted by pixiecrinkle at 10:52 AM on February 1, 2013 [1 favorite]

When I had a disk pressing on a nerve in my neck, among other (very painful) symptoms, I would very occasionally get a twitchy feeling in my throat.

So if you're going to see another doctor anyway, you may consider seeing an orthopedic specialist to rule out some kind of cervical spine issue.

But I am just a Regular Internet Person, and in no way do I know what I'm talking about, other than this anecdote.
posted by SuperSquirrel at 10:56 AM on February 1, 2013

Re: Celexa, it's a known phenomenon that that class of drugs (SSRIs) can help with long-term anxiety control, but at the cost of a short-term increase in anxiety while your body adjusts to the drug. Often for anxiety the starting dose is lower to try and prevent that short-term effect.

But if you hang in there, it might be effective. It's understandable if it's intolerable though.
posted by chiquitita at 1:43 PM on February 1, 2013

I cannot guarantee that it is anxiety, but I will say that as someone who has had periods of intense anxiety, I have caused myself symptoms like this.

Just a data point, I could have written almost exactly this post after the break up of my last long term relationship about six years ago. Except for me it was tingling scalp, foot and shoulder problems. I went through and almost identical "I am getting ALS and my doctors don't care!" problem. I would give the Celexa a chance to kick in or at least discuss what chiquitita has mentioned with your doctor. Since overcoming this particularly bad anxiety bout I am now slightly more mindful about whether or not Xanax makes my symptoms go away. I know it's scary, and I don't mean to belittle your feelings, but I suspect you may have a little of what I had.
posted by jessamyn at 3:49 PM on February 1, 2013

I had a time in my life where I had severe anxiety about my health. I had all sorts of weird twitching and tingling symptoms that I was 100 percent convinced were a neurological disease. (pretty similar to Frowner and Jessamyn) I went to doctors and they could find nothing wrong.

I finally decided the most logical and likely thing was that I had anxiety, which was causing symptoms, giving me more anxiety. I decided to treat it as anxiety and see if it responded to that. I saw a psychiatrist and was treated with prozac. The anxiety and related symptoms went away.
posted by Melsky at 11:22 PM on February 1, 2013

Also I found it very useful to get off the internet where I was looking up symptoms and do something that took my mind off things. I started reading series novels. I watched all the star wars movies in order. I painted while listening to books on tape. The more time you spend doing something else you're training your mind and body not to obsess on symptoms.
posted by Melsky at 12:32 AM on February 2, 2013

I had some pretty strong anxiety when I was younger, ended up feeling like my throat was closing when I had these panic attack-like things that weren't actually precipitated by an anxiety provoking event. It was weird. They would go away with a dose of benzodiazepene, ativan for me at the time.

Weirdly enough, it all went away a few years later when I hit 24 and suddenly, poof, I was bipolar, but I think all of my formal mental issues kinda flitted away when my mind went into bipolar mode. Seeing a neurologist might lead you down a rabbit-hole, as they will tend to order things like MRIs and CT scans. For now, just try to keep the anxiety in check and see what becomes of it. If it continues, perhaps the neurologist is the way to go? If all the cardiac stuff is normal, which it sounds like it is, the next step it to look into the muscle twitch/spasm and to identify where it is originating from.
posted by nursegracer at 10:13 AM on February 2, 2013

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